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Health Promotion, Education, and Behavior Theses and Dissertations

Theses/dissertations from 2023 2023.

Exploration of the Association Between Obesogenic Environments and Childhood Overweight/Obesity Rates In Rural Counties in the United States , Kara Lea Ferguson Davis

Social Network Attributes Associated With Conversations About Smoking And Cessation And Differences By Socioeconomic Status , Victoria Catherine Lambert

Babe (Body Appreciation and Better Eating), Just Add a Dash of Self-Compassion: A Randomized Controlled Pilot Study for Black/African American Teenage Girls , Nkechi Bianca Okpara

No More Loosies: A Mixed-Methods Study on the Implementation and Enforcement of the Loose Cigarette and Bidi Sale Ban in India , Mayank Sakhuja

Theses/Dissertations from 2022 2022

Food Insecurity Resilience of Refugee Families in the United States: A Qualitative Study , Maryam Suliman Alhabas

Homestead Vegetable and Poultry Production and Related Practices: An Assessment in Nepal , Shiva Bhandari

Living With Ulcerative Colitis: Exploring Dietary Inflammatory Intake, Physical Activity, and Methods to Manage the Burden of Illness , Kelli E. DuBois

Exploration of the Role of Neighborhood Residential Segregation by Race and Ethnicity in Obesity Risk Among School-Aged , Melissa L. Fair

Perspectives About Food Safety in Diverse Low- And Middle-Income Countries , Sejla Isanovic

Nutrition Facts Label Use Among U.S. Adolescents , Jennifer Beth Mandelbaum

HIV-Related Stigma, Sexual and Gender Minority-Related Stigma, and Health Outcomes Among MSM Living With HIV: Measurement, Impact, and Intersectionality , Tianyue Mi

Greenspace Across the United States: Exploring Equity and Associations With Physical Activity, Obesity, and Health-Related Quality of Life , Ellen W. Stowe

Theses/Dissertations from 2021 2021

Pre-Exposure Prophylaxis (PrEP) Knowledge, Willingness to Use & Uptake Among Black Heterosexual Men , Akeen Lowell Hamilton

A Contextual Evaluation of the Fresh Fruit and Vegetable Program in South Carolina and Related Child Health Behaviors , Kathryn Irene Hoy

Food Choice Decision-Making Among School-Going Adolescents Amidst the Nutrition Transition in Urban Accra, Ghana , Krystal Krsna Rampalli

Neighborhood Socioeconomic Status, Green Space, and Walkability and Risk for Falls and Fracture Among Postmenopausal Women: The Women’s Health Initiative , Marilyn Elizabeth Wende

Evaluation of a Clinic-Based Peer Navigation Program (PNP) For African Americans Living With HIV In South Carolina , Kimberly Butler Willis

Applying Health Stigma Framework to Examine the Mechanisms Of HIV-Related Stigma on Clinical Outcomes , Chengbo Zeng

Theses/Dissertations from 2020 2020

Determinants of Nutrition Agenda Setting in the Context of the Double Burden of Malnutrition in Tamil Nadu, India , Shilpa Vimalananda Constantinides

Understanding the Role of Political Commitment and Coherence Across Sectors and Across National and Sub-National Levels in Enabling Improvements in Nutrition in Rwanda , Elyse Iruhiriye

Rethinking the Customer Experience: An Empirical Comparison of Airbnb and Hotels , Jing Li

Does Marriage, Employment and Having Children Matter? A Secondary Analysis on Physical Activity Levels, Leisure Time Physical Activity, and Social Roles Among Women in the United States , Tramaine Paul McMullen

Influences on Parents’ Food Shopping for Children’s Consumption in South Carolina , Nazratun Nayeem Monalisa

Social Networks, the Local Food Environment, and Maternal Food Choice for Children Ages 1 to 5 Years Old in Rural Mexico , Ligia Ivette Reyes

Studying the “Snip”: A Multi-Methods Exploration of Vasectomy in the Southern United States , Ashley Lauren White

Examining the Organizational Capacity of Public Libraries That Offer Obesity Prevention Programs , Olivia Whitt

Theses/Dissertations from 2019 2019

Women’s Socio-Economic Empowerment and Uptake of HIV Testing in Ethiopia , Dawit Alemu

Role of Resources for Care in Improving Care Behaviors, Children’s Nutritional Status and Early Childhood Development in Low- and Middle-Income Countries , Sulochana Basnet

Social Networks, Social Support, and Contextual Factors That Affect Blood Glucose Control Among Individuals with Type 2 Diabetes Mellitus in Urban Ghana , Marian O. Botchway

Examining the Relationships Between Stress, Depressive Symptoms, and the Neighborhood Food Environment on Diet Quality Among Racially-Diverse Pregnant Women in South Carolina , Alycia K. Boutté

Experience of Persistent Pain Among Military Service Members Participating in an Interdisciplinary Intensive Outpatient Program , Barbara Katarzyna Bujak

The Plant-Based and Soul-Full Study (PASS): Examining How Owners of Local Vegan Soul Food Restaurants Promote the Consumption of Vegan Foods in the African American Community , Anthony Crimarco

Applying the Health Action Process Approach (HAPA) in Program Evaluation of a Theory-Based Parental HIV Disclosure Intervention Among Parents Living With HIV (PLH) in China , Wendi Da

Sociocultural Factors Influencing Cervical Cancer Prevention and Control Behaviors in Cusco, Peru , Venice Elizabeth Haynes

Evaluating Impacts of a Multilevel Resilience-Based Psychosocial Intervention on Mental Health of Children Affected by Parental HIV in China , Yanping Jiang

Expanding Immediate Postpartum Contraceptive Options: South Carolina’s Medicaid Policy , Amy Mattison-Faye

Parenting and Child Self-Regulation as Mechanisms for the Relationship of Household Food Insecurity with Child Dietary Behavior , Hoa Thi Mai Nguyen

Helping South Carolina’s Children Thrive: Promoting Protective Factors to Prevent the Long-Term Impact of Adverse Childhood Experiences Through the Development of Evidence-Based Public Health Policies , Aditi Srivastav

Pre-Exposure Prophylaxis (PrEP) for HIV Prevention: A Mixed-Methods Study of Sexual Risks and Knowledge, Perceptions, and Willingness of PrEP Use Among African American Women in the South , Jamie Troutman

Theses/Dissertations from 2018 2018

Healthy Motivations for Moms-To-Be (Healthy MoM2B) Study: A Mobile Health Intervention Targeting Gestational Weight Gain among U.S. Women , Alicia Anne Dahl

The Impact of False Positive Mammography Results on Breast Cancer Screening Intention Among Black Women , Deeonna E. Farr

Examining Faith-Based Communities As Leverage Points For The Prevention Of Childhood And Adolescent Obesity , Caroline Glagola Dunn

Body Mass Index Trajectories And The Relationship Between Stressful Life Changes And Nutrition-Related Health Outcomes Among United States Army Soldiers , Julianna Marie Jayne

Understanding The Mechanisms Linking Gendered Intrahousehold Bargaining Power And Child Nutrition In Rural Nepal , Shibani Kulkarni

Interpersonal Communication About Cigarette Warning Labels Among U.S. Smokers: Differences Between Latinos And Whites , Victoria Catherine Lambert

The Effects Of The Affordable Care Act On The Receipt Of Colonoscopies Among Insured Elderly , Min Jee Lee

Racism, Black College Students’ Mental Health, And The Efficacy Of Diversity And Inclusion Initiatives: A Case Study. , Kaleea R. Lewis

Intervention For Women In Costa Rica Who Are Discouraged And Have Food Insecurity And Excess Body Weight , Tatiana Martínez-Jaikel

The Effect Of Neighborhood Characteristics And Acculturation On Vegetable Intake Among U.S. Hispanics , Anna Victoria Mesa

A Qualitative Exploration Of Experiences And Motivations For Diabetes Self-Management In African American Men Between The Ages Of 40-85 With Type 2 Diabetes , Anthony Q. Walker

Theses/Dissertations from 2017 2017

Effectiveness of Pictorial Health Warning Labels for Indonesia's Cigarette Packages , Dien Anshari

“An Uphill Battle”: Psychosocial Health and Self-Care among Advocates who work Against Gender-Based Violence in South Carolina , Ebru Cayir

Exploring Spatial Patterning and the Impact of Obesogenic built Environments for Youth Obesity , S. Morgan Hughey

Involvement Of Men In Responsible Parenthood In Croatia, India, And Mexico: Major Factors, Correlates, And National Policy , Salima Kasymova

Multilevel and Multisectoral Processes of Implementing Nutritionsensitive Ideology and Programming in Ethiopia’s Development Landscape , Andrea Marie Warren

Theses/Dissertations from 2016 2016

Breastfeeding Among Working Mothers in Saudi Arabia , Maryam Suliman Alhabas

Social Capital And Social Networks: The Importance Of Social Ties For Health Among Residents Of Disadvantaged Communities , Stephanie Child

Implementation Processes And Impacts Of School Store Policies In South Korea , Seul Ki Choi

Conversations About Sexuality On A Public University Campus: Exploring Perspectives From Campus Ministry Leaders And Students , Charis Rebecca Davidson

Sleep Disruption and Cancer Incidence in a Southeastern Veteran Population , Alexandria F. Delage

Non-Steroidal Anti-Inflammatory Drug Effects On Core Temperature, Hydration, Gastrointestinal Distress, And Performance In Exercising Humans , Dawn Marie Emerson

Sustainability Of Food And Nutrition Security Policies During Presidential Transitions: Integrating Socio-Political And Nutritional Sciences , Jessica Liana Escobar-Alegría

A Qualitative Study Of How Communities Think About And Act Upon Hunger In The Presence Of A Food Banking System , Eliza Miriam Fishbein

Examining Crowdsourced Social Media Platforms And Their Association With College Students' Alcohol Consumption, Perceived Risk, And Behaviors , Danielle Gentile

Quality Over Quantity: Positive Interactions During Family Meals In Food-Insecure Households Compensate For The Negative Impacts Of Household Chaos On Child Emotional Well-Being, But Not Diet Quality , Tiara Nicόl Rosemond

Enhancing Parent-Child Communication and Promoting Physical Activity and Healthy Eating Through Mobile Technology: A Randomized Trial , Danielle E. Schoffman

Examining Infant Health Outcomes Impacted By South Carolina's Regionalized System of Perinatal Care , Michael Grady Smith

Understanding Conceptualizations and Structural Environment for Improving Pre-Pregnancy Planning for Adolescent Girls and Young Women in Harare, Zimbabwe , Chiwoneso Beverley Tinago

Bayesian Semiparametric Quantile Regression for Clustered Data , Xin Tong

The Roots Of Perspective In The American Context: News Media Discourse And Stakeholder Perspectives About The Supplemental Nutrition Assistance Program , Nicholas Younginer

Theses/Dissertations from 2015 2015

Telling a Different Narrative: Exploring the Values and Challenges of Performing Enslaved Community Members’ Stories at U.S. Southern Plantation Museums , Stefanie Kate Benjamin

Post-Fall Decision Making Among Older Women Living in Continuing Care Retirement Communities: A Mixed Methods Study , Caroline D. Bergeron

eCPAT: Development and Testing of Mobile Technology to Engage Youth in Active Living Policy, Systems, and Environmental Health Promotion Efforts , Gina M. Besenyi

Building Capacity for Advocacy for Local Food Systems Change: An Ethnographic Study Documenting the Process of Change in South Carolina Communities , Casey Denise Childers

Refinement and Pilot Testing Social Networks for Encouraging Healthy Behaviors: The Social Pounds Off Digitally (Social POD) Study , Sarah B. Hales

A Qualitative Study of the Massage Therapy Foundation's Best Practices Symposium: Clarifying Definitions and Creating a Framework for Practice , Ann Blair Kennedy

Support for Comprehensive Sexuality Education and Adolescent Access to Condoms and Contraceptions in South Carolina , Sarah H. Kershner

By Word of Mouth: A Qualitative Approach to Understanding the Integration of Preventive Dental Health in Primary Care Settings , Joni D. Nelson

Ethnic Discrimination: Measurement And Associations With Smoking-Related Outcomes Among Arab Male Current And Former Smokers In Israel , Amira Osman

Addressing Disparity: one Unique School’s Efforts to Provide Holistic Education in a low-income, Black Community , Allison Anne Parsons

The Influence of Self-Reported Degree of Masculinity/Femininity on Condom Use Among Black Men Who Have Sex with Men in the Deep South , Elizabeth D. Peeler

Framing Risk, Responsibility, and Resolution: A Mixed-Methods Study Exploring Traditional and Social Media Coverage of the 2014 Elk River Chemical Spill , Tracey Thomas

Statewide Scale-up of Group Prenatal Care in South Carolina , Kristin M. Van De Griend

Theses/Dissertations from 2014 2014

The Emergence of U.S. Hospital-Based Doula Programs , Violet Dawn Beets

The Association between the Social Context of Mealtime, Children's Diet, Caregiver's Experiences with Discrimination and Household Food Insecurity , Michael Patrick Burke

The Comparative Effectiveness of Group Prenatal Care on Women's Psychosocial Health , Emily Heberlein

The Development, Implementation, and Testing of an Interactive Sexual Health Web-Based Application Intervention to Reduce Sexual Risk Behaviors Among College Students , Dawnyéa Dominique Jackson

A Community-Driven Approach to the Development of a Digital Decision Aid to Facilitate Informed Decision Making for Prostate Cancer Screening among African-American Men in Communities of Faith , Otis LaShaun Owens

Elucidating Perceived and Actual Cancer Risk in Disadvantaged Neighborhoods Differentially Impacted by Environmental Hazards to Inform Future Public Health Interventions , LaShanta J. Rice

Food Insecurity and Physical Activity among U.S. populations , Quyen G. To

Theses/Dissertations from 2013 2013

Understanding Online and offline Sex Seeking Behavior Among Young Men Who Have Sex With Men: Implications For HIV/AIDS Interventions , Winston Eromosele Abara

Smokers' Neurological Responses to Imagery From Cigarette Package Warning Labels , Johann Fridrik Fridriksson

Exploring African American and White 18-19 Year Old Males' Communication Experiences With Their Parents and Partners About Sex and Contraception , Charlotte Toole Galloway

Investigating Developmental Patterns of Symptom and Impairment Change Among Youth With ADHD, Subthreshold ADHDand Youth Without ADHD , Lorie Love Geryk

Understanding the Early Stages of Development of A Global Health Partnership , Wendy Raquel Gonzalez Navarrete

Promoting Early Childhood Development Through Community Health Worker Interventions: Implementation and Measurement Issues In Rural Pakistan , Zaeem Haq

Evaluation of Mass Media Campaigns to Change Smokers' Knowledge, Attitudes, and Behaviors In China and Taiwan , Li-Ling Huang

Race, Ethnicity, and Differential Perceptions of Sexual Victimization (Assault) , Kaleea Regina Lewis

Postnatal Depression In Mexico: Healthcare Provider Conceptualizations and Policies In the Public Health Sector , Jean Marie Sims Place

Examining the Relationships Between Religiosity, Spirituality, Internalized Homonegativity, and Sexual Risk Behaviors Among African-American Men Who Have Sex With Men: The Sexual Health In Faith Traditions (SHIFT) Study , Stacy Whichard Smallwood

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Qualitative research methods in medical dissertations: an observational methodological study on prevalence and reporting quality of dissertation abstracts in a German university

Charlotte ullrich.

Department of General Practice and Health Services Research, University of Heidelberg Hospital, INF 130.3, 69120 Heidelberg, Germany

Anna Stürmlinger

Michel wensing, associated data.

The data of the repository databank is semi-public and can be accessed from the corresponding author upon reasonable request. A data extraction table is available in App. 2.Competing interests and funding: We have no conflicts of interest to disclose and no funding to report.

Qualitative methods offer a unique contribution to health research. Academic dissertations in the medical field provide an opportunity to explore research practice. Our aim was to assess the use of qualitative methods in dissertations in the medical field.

By means of a methodological observational study, an analysis of all academic medical dissertations’ abstracts between 1998 and 2018 in a repository databank of a large medical university faculty in Germany was performed. This included MD dissertations (Dr. med. (dent.)) and medical science dissertations (Dr. sc. hum.). All abstracts including “qualitativ*” were screened for studies using qualitative research methods. Data were extracted from abstracts using a category grid considering a) general characteristics (year, language, degree type), b) discipline, c) study design (mixed methods/qualitative only, data conduction, data analysis), d) sample (size and participants) and e) technologies used (data analysis software and recording technology). Thereby reporting quality was assessed.

In total, 103 abstracts of medical dissertations between 1998 and 2018 (1.4% of N  = 7619) were included, 60 of MD dissertations and 43 of medical sciences dissertations. Half of the abstracts ( n  = 51) referred to dissertations submitted since 2014. Most abstracts related to public health/hygiene ( n  = 27) and general practice ( n  = 26), followed by medical psychology ( n  = 19). About half of the studies ( n  = 47) used qualitative research methods exclusively, the other half ( n  = 56) used mixed methods. For data collection, primarily individual interviews were used ( n  = 80), followed by group interviews ( n  = 33) and direct observation ( n  = 11). Patients ( n  = 36), physicians ( n  = 36) and healthcare professionals ( n  = 17) were the most frequent research participants. Incomplete reporting of participants and data analysis was common ( n  = 67). Nearly half of the abstracts ( n  = 46) lacked information on how data was analysed, most of the remaining ( n  = 43) used some form of content analysis. In summary, 36 abstracts provided all crucial data (participants, sample size,; data collection and analysis method).

A small number of academic dissertations used qualitative research methods. About a third of these reported all key aspects of the methods used in the abstracts. Further research on the quality of choice and reporting of methods for qualitative research in dissertations is recommended.

Qualitative research methods offer a unique contribution to health research, particular for exploration of the experiences of patients, healthcare professionals and others [ 1 – 5 ]. While (general) epidemiology primarily addresses health and healthcare in populations and clinical research concentrates on medical interventions and health prognosis, qualitative research methods focus on different actors’ perspectives, experiences and behaviours in health-related contexts. Qualitative research entails a broad spectrum of methods of data conduction and data analysis: individual interviews illuminate individual perceptions [ 6 ], group interviews deliver insights into shared norms and opinions [ 7 ], direct observations facilitate understandings of behaviours in healthcare practice [ 8 – 10 ] and documents can offer insights into discourses and self-representations [ 11 ]. For data analysis, methods combining inductive and deductive steps are most suitable for exploratory research questions utilizing existing results, theories and concepts [ 12 ]. Given these prospects, little is known on the practice of applying qualitative research methods, especially concerning medicine.

In dissertations, a foundation for future scientific work is laid; therefore, guidance and rigour are of special importance [ 13 ]. Dissertations in medical departments provide a good opportunity to explore research practices of students and young academics. In Germany, about 60% of all graduating medical students complete an academic dissertation [ 14 ], which they usually finish parallel to medical school within a full-time equivalent of about a year [ 15 – 18 ]. As a by-product, medical doctoral students are increasingly among the authors of published research, holding first-authorship in about 25% [ 18 – 20 ].

In Germany, basic scientific training is a required part of the medical curriculum and recent policies put even more emphasis on the development of scientific competencies [ 15 , 21 , 22 ]. National regulations specify scientific competencies giving explicit recommendations for quantitative methods. Medical students have rarely received training in qualitative methods. However, health care professions and qualitative methods share a perspective directed to practice and interactions. Interviews and observations are already commonly used as clinical and diagnostic tools.

In addition to the doctoral degrees for medical and dental graduates (Doctor medicinae (dentariae), Dr. med. (dent.)), students with other disciplinary backgrounds (e.g. natural scientists, psychologists and social scientists) complete dissertations at medical faculties in Germany (often labelled Doctor scientiarum humanarum, Dr. sc. hum. or Doctor rerum medicarum, Dr. rer. medic.). Although regulations differ slightly, the degrees are usually situated within and regulated by the same institutional culture and context (e.g. faculty, department, supervision and aspired publications).

The aim of this study was to understand the current practice of applying qualitative research methods helping identify gaps in reporting and need for guidance. By means of a methodological study – a subtype of observational studies that evaluates the design, analysis of reporting of other research-related reports [ 23 ] – we investigated volume and variety of the use of qualitative research methods in dissertations at a German medical faculty. Hereby we wanted to inform methodological advances to health research and outline implications for medical education in scientific competencies training.

Search strategy

Dissertations in the medical field were retrospectively assessed: In a document analysis, all dissertation abstracts at one medical faculty were reviewed. This faculty was chosen as it is one of the oldest and largest medical faculties in Germany, with a strong research tradition and a high dissertation rate among graduating students. All abstracts from 01/01/1998 to 31/12/2018, which were publicly available in the repository databank of the university, were reviewed. This included MD dissertations (Dr. med. (dent.)) and medical science dissertations (Dr. sc. hum.) written in German or English. All types of studies using qualitative research methods, all types of human participants, all types of interventions and all types of measures were eligible. We focused on abstracts, because full text dissertations are not publicly available and are helpful to get an overview of a number of method-related issues. Although serving as a proxy, abstracts should provide a sufficient summary of the dissertation, including crucial information on study design, independently from the full text. In the databank, relevant documents had to be labelled a) “abstract of a medical dissertation” (referring to both degree types). To further identify dissertations using qualitative methods b) the search term “qualitativ*” was used as an inclusion criterium.

Selection and data extraction

All identified abstracts were pre-screened independently by two researchers (AS, LS) and then reviewed by the main research team (KK, AS, CU) excluding abstracts using “qualitativ*” only in respect to non-methods-related issues (e.g. quality of life). Data on a) general characteristics (year, language, degree type), b) discipline, c) study design (mixed methods/qualitative only, data conduction, data analysis), d) sample (size and participants) and e) technologies used (data analysis software and recording technology) (see App. 2) was then extracted independently by two team members (AS, LS) and crossed-checked (KK, CU). Data extraction was initially guided by two widely used reporting guidelines for qualitative health research articles [ 24 , 25 ] and adapted to reflect the abstract format: Abstracts provided comparable information on the set-up of study design and sample. Reporting of results was not assessed due to heterogeneity and briefness. Data extraction forms were piloted and adjusted to inductive findings. Disagreements were discussed, assessed and solved by consensus by the main research team (KK, AS, CU). Extracted data were analysed and reported as absolute and relative frequencies. As all abstracts were available, no further data was obtained from authors.

Search results

Out of a total of 7619 dissertation abstracts, 296 dissertations were initially identified. Of these, 173 abstracts were excluded from the study as “qualitativ*” in these abstracts did not refer to the research method. Additionally, 20 abstracts (12 medicine, 8 medical science) were not further included in the analysis due to an ambiguous and inconclusive use of the label “qualitative methods” and/or restricted comparability with the otherwise pre-dominant interview-based study designs: a) a qualitative research design was stated, but no further information on the approach was given ( n  = 7), b) no explicit distinction was made between qualitative research design and a clinical diagnostic approach ( n  = 4), c) the qualitative approach comprised of additional free text answers in written questionnaires only ( n  = 6), and d) only document analysis or observation was used ( n  = 3). In total, 103 abstracts (1.4% of 7619) were included in the analysis.

Low but increasing use

Since 1998, the number of dissertations applying qualitative methods has continually increased while the total number of dissertations remained stable (between n  = 314 in 2006 and n  = 410 in 1999 and 2008, M (1998–2018) = 362.8, SD = 26.1) (Fig.  1 ). Before 2005 there was yearly not more than one dissertation that used qualitative methods. Since then, the number has steadily raised to more than 10 dissertations per year, equivalent to an increase from 0.28% in 1998 to 3.42% in 2018 of all listed dissertation abstracts per year.

Number of all dissertations and dissertations using qualitative methods per year between 1998 and 2018

General characteristics

Abstracts nearly equally referred to dissertations leading to an MD degree (Dr. med. n  = 57, Dr. med. Dent. n  = 3) and medical science degree (Dr. sc. hum. n  = 43), respectively. The included dissertation abstracts were based in 12 different sub-specialties , most in general practice ( n  = 26), in public health and hygiene ( n  = 27) and medical psychology ( n  = 19); the Dr. med. (dent.) abstracts having a higher share in general practice ( n  = 21) and the Dr. sc. hum. abstracts in public health/hygiene ( n  = 16) (s. Table  1 ).

Usage of qualitative research design in dissertations at a medical faculty

Most abstracts followed at least roughly the common structure of background, methods, results and conclusion. The length of the abstracts varied between less than one and more than three pages, with most abstracts being one to two pages long; 77 abstracts were written in German and 26 in English.

Study design

About half of the studies used qualitative research methods exclusively ( n  = 47; 60% of Dr. med. (dent.) abstracts, 26% of Dr. sc. hum. abstracts), the other half mixed methods ( n  = 56; 40% of Dr. med. (dent.) abstracts, 74% of Dr. sc. hum. abstracts; Table ​ Table1). 1 ). Individual interviews were the most common form of data collection ( n  = 80), followed by group interviews ( n  = 33) and observation ( n  = 11). In total, 23 abstracts indicated the use of a combination of different qualitative methods of data conduction, all of these included individual interviews. For documentation/recording, when reported ( n  = 37), audio recording was used in most cases ( n  = 3).

Little difference regarding method of data conduction were found between pure qualitative and mixed-methods designs. Mixed methods studies rather included physicians ( n  = 21) and used predominantly general content analysis ( n  = 14), when reported; whereas qualitative studies rather included patients ( n  = 28) and used predominantly both content analysis ( n  = 14) and content analysis following Mayring ( n  = 12). Overall incomplete reporting was more common in mixed-method studies ( n  = 41) than qualitative studies ( n  = 26, 55.3%) (see App. 2).

Sample size varied widely: Overall, 67 abstracts provided a sample size. Of those, a median number of 29 people (min-max: 2–136) participated in individual and group interviews. Only in Dr. sc. hum. dissertations using mixed methods, lower median sample sizes were reported for the qualitative part (Md = 22, min-max: 6–110; n  = 17) compared to dissertations using qualitative methods only (medical science ( n  = 7): Md = 31, min-max: 16–50; MD ( n  = 29): Md = 29, min-max: 7–136) and Dr. med. (dent.) dissertations with mixed methods (Md = 30, min-max: 2–62; n  = 14). In individual interviews, when sample size was reported ( n  = 55, 69% of 80), it distributed roughly equally in the ranges of 1–10, 11–20, 21–30, 31–50 and above 50 (Md = 25; min-max: 2–110). For the 33 dissertations using group interviews, the number of groups is given in 20 abstracts, the number of participants in 15 abstracts. Between 1 and 24 group interviews were conducted with a median total of 24 participants (min-max: 2–65) (see Table ​ Table1 1 ).

Patients ( n  = 36) and physicians ( n  = 36) were the overall most frequent research participants , followed by other health care professionals ( n  = 17), students ( n  = 11) and relatives of patients ( n  = 7). Other participants ( n  = 16) included: representatives of self-help organizations and other experts, educators such as teachers and policy makers. In 33% ( n  = 31) of the abstracts, more than one participant group was included, 6.8% ( n  = 7) did not specify research participants. While MD dissertations predominantly included physicians ( n  = 27) and patients ( n  = 19), Dr. sc. hum. dissertations included mostly patients ( n  = 17) and other participants ( n  = 10).

Data analysis

For data analysis, if reported ( n  = 57), content analyses were the most common used method ( n  = 42), including the highly deductive approach formulated by Mayring [ 26 ] ( n  = 16), mostly used in MD dissertations ( n  = 14). Among other reported methods ( n  = 15), grounded theory ( n  = 5) was the most common approach; rarely mentioned methods include framework analysis and non-specific analysis combining inductive and deductive approaches. Forty-six abstracts did not provide information on the analysis method used (38.3% of MD abstracts, 53% of medical science abstracts). If reported ( n  = 24), ATLAS.ti ( n  = 14), MAXQDA ( n  = 3) and NVivo ( n  = 3) were mentioned most frequently as qualitative data analysis programs.

In summary, 36 abstracts provided all crucial data (participants: sample size, characteristics, i.e. healthcare professional/patient; data collection and analysis method). Thus, 58% ( n  = 35) of MD dissertation abstracts and 74% ( n  = 32) of Dr. sc. hum. dissertation abstracts had at least one missing information.

The results show a low but increasing use of qualitative research methods in medical dissertations. Abstracts nearly equally referred to dissertations leading to an MD degree and medical science doctorate respectively; half of which were submitted since 2011. Qualitative methods were used in several departments, most frequently in those for general practice, public health and medical psychology mirroring an already known affinity between the objective of certain medical disciplines and perspective qualitative methods [ 27 , 28 ].

About half of the studies used qualitative research methods exclusively, the other half mixed methods: While some differences were found, due to short format and sparse information within the abstract a strict differentiation between qualitative approaches alone and combined quantitative and qualitative designs was not made. Little difference according to degree type was observed. This points to a strong shared dissertation culture, that balances and conceals differences in academic training between medical students and graduates from other, quite diverse, disciplines (e.g. from humanities, natural and social sciences) pursuing a doctorate at a medical faculty.

Limited variety in methods used

The results show a strong preference for certain methods in data conduction, research participants and data analysis: Individual and group interviews were predominant as well as content analysis, especially Mayring’s deductive approach. All in all, a limited use of the broad spectrum of qualitative research methods can be observed. Interviews are important to gain insights on actors’ perspective [ 6 ]; however, they have limited information value when it comes to actual processes and practice of health care. To investigates those, additional direct observation would be suitable [ 8 , 9 ]. In group interviews shared norms and opions can be observed, they are not suitable to capture individual perspectices. Group interviews go along with higher time and efforts regarding scheduling, interview guidance and data analysis [ 7 ]. Within the dissertations, documents are rarely used as data within the dissertations, but could be useful readily available documents.

Included research participants were mostly patients and physicians. This might be due to the research questions posed or the availability of participants. However, to reflect the complexity of health care a higher diversity of research questions, expanding participants (e.g. other health care professionals and caregivers) and based on a thorough knowledge of available methods, including qualitative approaches, might be needed.

As for methods of analysis, the results show a predominant use of a form of content analysis, with a strong affinity to quantitative analysis often limited to description forgoing in-depth analysis. As qualitative methods belong to the interpretative paradigm, most qualitative methodologies emphasize inductive analyses (e.g. Grounded Theory) and/or a combination of induction and deduction [ 12 , 29 ]. By using primarily descriptive content analysis the full potential of qualitative research and depth of the data to gain new a insights are thus neglected. Since knowledge about and application of qualitative methods are not part of the medical curriculum, doctoral students lack training in using qualitative methods and grasping the possibilities these methods convey for in-depth original knowledge.

Incomplete reporting

One fundamental principle of good research practice is accurate reporting. For empirical research, reporting on research design and methods is crucial to ensure comparability and reflect reach of research results. Within medicine and other health sciences, while debated [ 30 ], reporting guidelines are increasingly used to guarantee a basic standard. While qualitative research designs differ from clinical and quantitative designs regarding theoretical and methodological background, study aims and research process, rigorous reporting is a shared standard: this includes reporting on data conduction, sampling, participants and data analysis (e.g. COREQ [ 24 ]).

In our study, incomplete reporting regarding research design and methods was common. Especially, information on methods of data analysis was missing in about half of the abstracts reflecting the limited awareness of the plethora of qualitative analysis methods. Additionally, a third of the abstracts did not provide information on sample size. Although the importance of a “sufficient” sample size is controversially discussed, identifying the sources and putting their contributions into perspective is a paramount characteristic of qualitative research [ 31 – 33 ]. All in all, incomplete reporting was common ( n  = 67). Additionally, out of 123 initially identified abstracts, 20 had to be excluded from the analysis as comparability was not given mainly due to the inconclusive use of the term qualitative methods.

Several issues should be considered when interpreting the findings from this study. As a case study at one large faculty, which has a strong research orientation, the generalizability of the findings is uncertain. It seems unlikely that the quality of reporting is better in other medical faculties in Germany, but the prevalence of using qualitative methods might be higher. Character and role of the abstracts might not be as apparent as in journal papers, as they serve as a summary of the dissertation and are listed within the online repository databank only. The relation of reporting quality of those abstracts and the full text dissertation or even publication is unknown. Presentation of results was not assessed as information in abstracts were brief and heterogenous. Additionally, insights are limited by the structure of the repository databank itself, i.e. sub-disciplines are combined that sometimes cover distinct research fields or did evolve as separate specialties. All in all, however, the results mirror the critique on the lack of scientific training in medical education [ 17 , 22 , 34 , 35 ] and the want of sufficient reporting in medicine and health science, irrespective of study design [ 36 ].

While recent policies put a strong emphasis on strengthening scientific competences in medical education in Germany [ 15 , 21 , 22 ], especially MD dissertations are only in some degree comparable to dissertation thesis of other disciplines and medical dissertations internationally: In Germany, about 60% of all graduating medical students complete an academic dissertation [ 14 ], which they usually finish parallel to medical school within a full-time equivalent of about a year [ 15 – 18 ]. Graduate programs that exclusively dedicate 1 year for pursuing a dissertation are still discussed as innovative [ 35 ]. Additionally, the expertise of supervisors was not assessed. In a recent opinion paper, Malterud et al. [ 37 ] called for supervisors and dissertation committees holding corresponding methodological skills and experience as well as an academic consensus regarding scientific rigour to ensure high quality theses using qualitative methods. Missing standards in supervision and reporting might have led to the observed results in our study.

Qualitative research methods offer a unique scientific benefit to health care, including medicine. Our results show that within dissertation research, the number of dissertations applying qualitative methods has continually increased mirroring an overall trend in health research. To improve reach and results, a broader spectrum of qualitative methods should be considered when selecting research designs, including e.g. (direct) observation, document and analysis strategies, that combine inductive and deductive approaches. Same holds true for including a more diverse body of research participants. More broadly, reporting and academic practice should be improved.

Reporting guidelines can not only help to improve the quality of reporting but also be used as a tool to supervising graduate students steps commonly associated with qualitative research methods. So far, however, reporting guidelines mainly target full and/or published papers. Still, some reporting guidelines for abstracts are already available [ 38 – 41 ], that could be adapted for dissertation research in health science.

In academic practice, skilled supervision alongside transparent and method-appropriate criteria are the precondition for confident and courageous dissertation research that increases understanding and challenges existing knowledge of health care research. Educational programs strengthening research and reporting skills – within and beyond qualitative methods – should be implemented into medical education more profoundly, at the latest in doctoral training.

Acknowledgements

We would like to thank Laura Svensson for assisting in reviewing the abstracts and data extraction. In addition, we would like to thank the reviewers for their thorough review and constructive comments.

Abbreviations

Authors’ contributions.

CU and KK conceived the idea for this manuscript. CU, KK and AS reviewed, extracted and analyzed the data. KK led the data analysis. CU wrote the first draft of the manuscript. MW provided substantial comments at different stages of the manuscript. CU, KK and MW critically revised the manuscript. All authors read and approved the manuscript for submission.

Open Access funding enabled and organized by Projekt DEAL.

Availability of data and materials

Ethics approval and consent to participate.

Not applicable. In accordance with the scope and design of this study no formal study protocol was written.

Consent for publication

Not applicable.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Contributor Information

Charlotte Ullrich, Email: [email protected] .

Anna Stürmlinger, Email: [email protected] .

Michel Wensing, Email: [email protected] .

Katja Krug, Email: [email protected] .

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• Published: 10 December 2020

Qualitative research methods in medical dissertations: an observational methodological study on prevalence and reporting quality of dissertation abstracts in a German university

• Charlotte Ullrich   ORCID: orcid.org/0000-0002-9757-913X 1 ,
• Anna Stürmlinger 1 ,
• Michel Wensing 1 &
• Katja Krug 1  

BMC Medical Research Methodology volume  20 , Article number:  301 ( 2020 ) Cite this article

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Qualitative methods offer a unique contribution to health research. Academic dissertations in the medical field provide an opportunity to explore research practice. Our aim was to assess the use of qualitative methods in dissertations in the medical field.

By means of a methodological observational study, an analysis of all academic medical dissertations’ abstracts between 1998 and 2018 in a repository databank of a large medical university faculty in Germany was performed. This included MD dissertations (Dr. med. (dent.)) and medical science dissertations (Dr. sc. hum.). All abstracts including “qualitativ*” were screened for studies using qualitative research methods. Data were extracted from abstracts using a category grid considering a) general characteristics (year, language, degree type), b) discipline, c) study design (mixed methods/qualitative only, data conduction, data analysis), d) sample (size and participants) and e) technologies used (data analysis software and recording technology). Thereby reporting quality was assessed.

In total, 103 abstracts of medical dissertations between 1998 and 2018 (1.4% of N  = 7619) were included, 60 of MD dissertations and 43 of medical sciences dissertations. Half of the abstracts ( n  = 51) referred to dissertations submitted since 2014. Most abstracts related to public health/hygiene ( n  = 27) and general practice ( n  = 26), followed by medical psychology ( n  = 19). About half of the studies ( n  = 47) used qualitative research methods exclusively, the other half ( n  = 56) used mixed methods. For data collection, primarily individual interviews were used ( n  = 80), followed by group interviews ( n  = 33) and direct observation ( n  = 11). Patients ( n  = 36), physicians ( n  = 36) and healthcare professionals ( n  = 17) were the most frequent research participants. Incomplete reporting of participants and data analysis was common ( n  = 67). Nearly half of the abstracts ( n  = 46) lacked information on how data was analysed, most of the remaining ( n  = 43) used some form of content analysis. In summary, 36 abstracts provided all crucial data (participants, sample size,; data collection and analysis method).

A small number of academic dissertations used qualitative research methods. About a third of these reported all key aspects of the methods used in the abstracts. Further research on the quality of choice and reporting of methods for qualitative research in dissertations is recommended.

Peer Review reports

Qualitative research methods offer a unique contribution to health research, particular for exploration of the experiences of patients, healthcare professionals and others [ 1 , 2 , 3 , 4 , 5 ]. While (general) epidemiology primarily addresses health and healthcare in populations and clinical research concentrates on medical interventions and health prognosis, qualitative research methods focus on different actors’ perspectives, experiences and behaviours in health-related contexts. Qualitative research entails a broad spectrum of methods of data conduction and data analysis: individual interviews illuminate individual perceptions [ 6 ], group interviews deliver insights into shared norms and opinions [ 7 ], direct observations facilitate understandings of behaviours in healthcare practice [ 8 , 9 , 10 ] and documents can offer insights into discourses and self-representations [ 11 ]. For data analysis, methods combining inductive and deductive steps are most suitable for exploratory research questions utilizing existing results, theories and concepts [ 12 ]. Given these prospects, little is known on the practice of applying qualitative research methods, especially concerning medicine.

In dissertations, a foundation for future scientific work is laid; therefore, guidance and rigour are of special importance [ 13 ]. Dissertations in medical departments provide a good opportunity to explore research practices of students and young academics. In Germany, about 60% of all graduating medical students complete an academic dissertation [ 14 ], which they usually finish parallel to medical school within a full-time equivalent of about a year [ 15 , 16 , 17 , 18 ]. As a by-product, medical doctoral students are increasingly among the authors of published research, holding first-authorship in about 25% [ 18 , 19 , 20 ].

In Germany, basic scientific training is a required part of the medical curriculum and recent policies put even more emphasis on the development of scientific competencies [ 15 , 21 , 22 ]. National regulations specify scientific competencies giving explicit recommendations for quantitative methods. Medical students have rarely received training in qualitative methods. However, health care professions and qualitative methods share a perspective directed to practice and interactions. Interviews and observations are already commonly used as clinical and diagnostic tools.

In addition to the doctoral degrees for medical and dental graduates (Doctor medicinae (dentariae), Dr. med. (dent.)), students with other disciplinary backgrounds (e.g. natural scientists, psychologists and social scientists) complete dissertations at medical faculties in Germany (often labelled Doctor scientiarum humanarum, Dr. sc. hum. or Doctor rerum medicarum, Dr. rer. medic.). Although regulations differ slightly, the degrees are usually situated within and regulated by the same institutional culture and context (e.g. faculty, department, supervision and aspired publications).

The aim of this study was to understand the current practice of applying qualitative research methods helping identify gaps in reporting and need for guidance. By means of a methodological study – a subtype of observational studies that evaluates the design, analysis of reporting of other research-related reports [ 23 ] – we investigated volume and variety of the use of qualitative research methods in dissertations at a German medical faculty. Hereby we wanted to inform methodological advances to health research and outline implications for medical education in scientific competencies training.

Search strategy

Dissertations in the medical field were retrospectively assessed: In a document analysis, all dissertation abstracts at one medical faculty were reviewed. This faculty was chosen as it is one of the oldest and largest medical faculties in Germany, with a strong research tradition and a high dissertation rate among graduating students. All abstracts from 01/01/1998 to 31/12/2018, which were publicly available in the repository databank of the university, were reviewed. This included MD dissertations (Dr. med. (dent.)) and medical science dissertations (Dr. sc. hum.) written in German or English. All types of studies using qualitative research methods, all types of human participants, all types of interventions and all types of measures were eligible. We focused on abstracts, because full text dissertations are not publicly available and are helpful to get an overview of a number of method-related issues. Although serving as a proxy, abstracts should provide a sufficient summary of the dissertation, including crucial information on study design, independently from the full text. In the databank, relevant documents had to be labelled a) “abstract of a medical dissertation” (referring to both degree types). To further identify dissertations using qualitative methods b) the search term “qualitativ*” was used as an inclusion criterium.

Selection and data extraction

All identified abstracts were pre-screened independently by two researchers (AS, LS) and then reviewed by the main research team (KK, AS, CU) excluding abstracts using “qualitativ*” only in respect to non-methods-related issues (e.g. quality of life). Data on a) general characteristics (year, language, degree type), b) discipline, c) study design (mixed methods/qualitative only, data conduction, data analysis), d) sample (size and participants) and e) technologies used (data analysis software and recording technology) (see App. 2) was then extracted independently by two team members (AS, LS) and crossed-checked (KK, CU). Data extraction was initially guided by two widely used reporting guidelines for qualitative health research articles [ 24 , 25 ] and adapted to reflect the abstract format: Abstracts provided comparable information on the set-up of study design and sample. Reporting of results was not assessed due to heterogeneity and briefness. Data extraction forms were piloted and adjusted to inductive findings. Disagreements were discussed, assessed and solved by consensus by the main research team (KK, AS, CU). Extracted data were analysed and reported as absolute and relative frequencies. As all abstracts were available, no further data was obtained from authors.

Search results

Out of a total of 7619 dissertation abstracts, 296 dissertations were initially identified. Of these, 173 abstracts were excluded from the study as “qualitativ*” in these abstracts did not refer to the research method. Additionally, 20 abstracts (12 medicine, 8 medical science) were not further included in the analysis due to an ambiguous and inconclusive use of the label “qualitative methods” and/or restricted comparability with the otherwise pre-dominant interview-based study designs: a) a qualitative research design was stated, but no further information on the approach was given ( n  = 7), b) no explicit distinction was made between qualitative research design and a clinical diagnostic approach ( n  = 4), c) the qualitative approach comprised of additional free text answers in written questionnaires only ( n  = 6), and d) only document analysis or observation was used ( n  = 3). In total, 103 abstracts (1.4% of 7619) were included in the analysis.

Low but increasing use

Since 1998, the number of dissertations applying qualitative methods has continually increased while the total number of dissertations remained stable (between n  = 314 in 2006 and n  = 410 in 1999 and 2008, M (1998–2018) = 362.8, SD = 26.1) (Fig.  1 ). Before 2005 there was yearly not more than one dissertation that used qualitative methods. Since then, the number has steadily raised to more than 10 dissertations per year, equivalent to an increase from 0.28% in 1998 to 3.42% in 2018 of all listed dissertation abstracts per year.

Number of all dissertations and dissertations using qualitative methods per year between 1998 and 2018

General characteristics

Abstracts nearly equally referred to dissertations leading to an MD degree (Dr. med. n  = 57, Dr. med. Dent. n  = 3) and medical science degree (Dr. sc. hum. n  = 43), respectively. The included dissertation abstracts were based in 12 different sub-specialties , most in general practice ( n  = 26), in public health and hygiene ( n  = 27) and medical psychology ( n  = 19); the Dr. med. (dent.) abstracts having a higher share in general practice ( n  = 21) and the Dr. sc. hum. abstracts in public health/hygiene ( n  = 16) (s. Table  1 ).

Most abstracts followed at least roughly the common structure of background, methods, results and conclusion. The length of the abstracts varied between less than one and more than three pages, with most abstracts being one to two pages long; 77 abstracts were written in German and 26 in English.

Study design

About half of the studies used qualitative research methods exclusively ( n  = 47; 60% of Dr. med. (dent.) abstracts, 26% of Dr. sc. hum. abstracts), the other half mixed methods ( n  = 56; 40% of Dr. med. (dent.) abstracts, 74% of Dr. sc. hum. abstracts; Table 1 ). Individual interviews were the most common form of data collection ( n  = 80), followed by group interviews ( n  = 33) and observation ( n  = 11). In total, 23 abstracts indicated the use of a combination of different qualitative methods of data conduction, all of these included individual interviews. For documentation/recording, when reported ( n  = 37), audio recording was used in most cases ( n  = 3).

Little difference regarding method of data conduction were found between pure qualitative and mixed-methods designs. Mixed methods studies rather included physicians ( n  = 21) and used predominantly general content analysis ( n  = 14), when reported; whereas qualitative studies rather included patients ( n  = 28) and used predominantly both content analysis ( n  = 14) and content analysis following Mayring ( n  = 12). Overall incomplete reporting was more common in mixed-method studies ( n  = 41) than qualitative studies ( n  = 26, 55.3%) (see App. 2).

Sample size varied widely: Overall, 67 abstracts provided a sample size. Of those, a median number of 29 people (min-max: 2–136) participated in individual and group interviews. Only in Dr. sc. hum. dissertations using mixed methods, lower median sample sizes were reported for the qualitative part (Md = 22, min-max: 6–110; n  = 17) compared to dissertations using qualitative methods only (medical science ( n  = 7): Md = 31, min-max: 16–50; MD ( n  = 29): Md = 29, min-max: 7–136) and Dr. med. (dent.) dissertations with mixed methods (Md = 30, min-max: 2–62; n  = 14). In individual interviews, when sample size was reported ( n  = 55, 69% of 80), it distributed roughly equally in the ranges of 1–10, 11–20, 21–30, 31–50 and above 50 (Md = 25; min-max: 2–110). For the 33 dissertations using group interviews, the number of groups is given in 20 abstracts, the number of participants in 15 abstracts. Between 1 and 24 group interviews were conducted with a median total of 24 participants (min-max: 2–65) (see Table 1 ).

Patients ( n  = 36) and physicians ( n  = 36) were the overall most frequent research participants , followed by other health care professionals ( n  = 17), students ( n  = 11) and relatives of patients ( n  = 7). Other participants ( n  = 16) included: representatives of self-help organizations and other experts, educators such as teachers and policy makers. In 33% ( n  = 31) of the abstracts, more than one participant group was included, 6.8% ( n  = 7) did not specify research participants. While MD dissertations predominantly included physicians ( n  = 27) and patients ( n  = 19), Dr. sc. hum. dissertations included mostly patients ( n  = 17) and other participants ( n  = 10).

Data analysis

For data analysis, if reported ( n  = 57), content analyses were the most common used method ( n  = 42), including the highly deductive approach formulated by Mayring [ 26 ] ( n  = 16), mostly used in MD dissertations ( n  = 14). Among other reported methods ( n  = 15), grounded theory ( n  = 5) was the most common approach; rarely mentioned methods include framework analysis and non-specific analysis combining inductive and deductive approaches. Forty-six abstracts did not provide information on the analysis method used (38.3% of MD abstracts, 53% of medical science abstracts). If reported ( n  = 24), ATLAS.ti ( n  = 14), MAXQDA ( n  = 3) and NVivo ( n  = 3) were mentioned most frequently as qualitative data analysis programs.

In summary, 36 abstracts provided all crucial data (participants: sample size, characteristics, i.e. healthcare professional/patient; data collection and analysis method). Thus, 58% ( n  = 35) of MD dissertation abstracts and 74% ( n  = 32) of Dr. sc. hum. dissertation abstracts had at least one missing information.

The results show a low but increasing use of qualitative research methods in medical dissertations. Abstracts nearly equally referred to dissertations leading to an MD degree and medical science doctorate respectively; half of which were submitted since 2011. Qualitative methods were used in several departments, most frequently in those for general practice, public health and medical psychology mirroring an already known affinity between the objective of certain medical disciplines and perspective qualitative methods [ 27 , 28 ].

About half of the studies used qualitative research methods exclusively, the other half mixed methods: While some differences were found, due to short format and sparse information within the abstract a strict differentiation between qualitative approaches alone and combined quantitative and qualitative designs was not made. Little difference according to degree type was observed. This points to a strong shared dissertation culture, that balances and conceals differences in academic training between medical students and graduates from other, quite diverse, disciplines (e.g. from humanities, natural and social sciences) pursuing a doctorate at a medical faculty.

Limited variety in methods used

The results show a strong preference for certain methods in data conduction, research participants and data analysis: Individual and group interviews were predominant as well as content analysis, especially Mayring’s deductive approach. All in all, a limited use of the broad spectrum of qualitative research methods can be observed. Interviews are important to gain insights on actors’ perspective [ 6 ]; however, they have limited information value when it comes to actual processes and practice of health care. To investigates those, additional direct observation would be suitable [ 8 , 9 ]. In group interviews shared norms and opions can be observed, they are not suitable to capture individual perspectices. Group interviews go along with higher time and efforts regarding scheduling, interview guidance and data analysis [ 7 ]. Within the dissertations, documents are rarely used as data within the dissertations, but could be useful readily available documents.

Included research participants were mostly patients and physicians. This might be due to the research questions posed or the availability of participants. However, to reflect the complexity of health care a higher diversity of research questions, expanding participants (e.g. other health care professionals and caregivers) and based on a thorough knowledge of available methods, including qualitative approaches, might be needed.

As for methods of analysis, the results show a predominant use of a form of content analysis, with a strong affinity to quantitative analysis often limited to description forgoing in-depth analysis. As qualitative methods belong to the interpretative paradigm, most qualitative methodologies emphasize inductive analyses (e.g. Grounded Theory) and/or a combination of induction and deduction [ 12 , 29 ]. By using primarily descriptive content analysis the full potential of qualitative research and depth of the data to gain new a insights are thus neglected. Since knowledge about and application of qualitative methods are not part of the medical curriculum, doctoral students lack training in using qualitative methods and grasping the possibilities these methods convey for in-depth original knowledge.

Incomplete reporting

One fundamental principle of good research practice is accurate reporting. For empirical research, reporting on research design and methods is crucial to ensure comparability and reflect reach of research results. Within medicine and other health sciences, while debated [ 30 ], reporting guidelines are increasingly used to guarantee a basic standard. While qualitative research designs differ from clinical and quantitative designs regarding theoretical and methodological background, study aims and research process, rigorous reporting is a shared standard: this includes reporting on data conduction, sampling, participants and data analysis (e.g. COREQ [ 24 ]).

In our study, incomplete reporting regarding research design and methods was common. Especially, information on methods of data analysis was missing in about half of the abstracts reflecting the limited awareness of the plethora of qualitative analysis methods. Additionally, a third of the abstracts did not provide information on sample size. Although the importance of a “sufficient” sample size is controversially discussed, identifying the sources and putting their contributions into perspective is a paramount characteristic of qualitative research [ 31 , 32 , 33 ]. All in all, incomplete reporting was common ( n  = 67). Additionally, out of 123 initially identified abstracts, 20 had to be excluded from the analysis as comparability was not given mainly due to the inconclusive use of the term qualitative methods.

Several issues should be considered when interpreting the findings from this study. As a case study at one large faculty, which has a strong research orientation, the generalizability of the findings is uncertain. It seems unlikely that the quality of reporting is better in other medical faculties in Germany, but the prevalence of using qualitative methods might be higher. Character and role of the abstracts might not be as apparent as in journal papers, as they serve as a summary of the dissertation and are listed within the online repository databank only. The relation of reporting quality of those abstracts and the full text dissertation or even publication is unknown. Presentation of results was not assessed as information in abstracts were brief and heterogenous. Additionally, insights are limited by the structure of the repository databank itself, i.e. sub-disciplines are combined that sometimes cover distinct research fields or did evolve as separate specialties. All in all, however, the results mirror the critique on the lack of scientific training in medical education [ 17 , 22 , 34 , 35 ] and the want of sufficient reporting in medicine and health science, irrespective of study design [ 36 ].

While recent policies put a strong emphasis on strengthening scientific competences in medical education in Germany [ 15 , 21 , 22 ], especially MD dissertations are only in some degree comparable to dissertation thesis of other disciplines and medical dissertations internationally: In Germany, about 60% of all graduating medical students complete an academic dissertation [ 14 ], which they usually finish parallel to medical school within a full-time equivalent of about a year [ 15 , 16 , 17 , 18 ]. Graduate programs that exclusively dedicate 1 year for pursuing a dissertation are still discussed as innovative [ 35 ]. Additionally, the expertise of supervisors was not assessed. In a recent opinion paper, Malterud et al. [ 37 ] called for supervisors and dissertation committees holding corresponding methodological skills and experience as well as an academic consensus regarding scientific rigour to ensure high quality theses using qualitative methods. Missing standards in supervision and reporting might have led to the observed results in our study.

Qualitative research methods offer a unique scientific benefit to health care, including medicine. Our results show that within dissertation research, the number of dissertations applying qualitative methods has continually increased mirroring an overall trend in health research. To improve reach and results, a broader spectrum of qualitative methods should be considered when selecting research designs, including e.g. (direct) observation, document and analysis strategies, that combine inductive and deductive approaches. Same holds true for including a more diverse body of research participants. More broadly, reporting and academic practice should be improved.

Reporting guidelines can not only help to improve the quality of reporting but also be used as a tool to supervising graduate students steps commonly associated with qualitative research methods. So far, however, reporting guidelines mainly target full and/or published papers. Still, some reporting guidelines for abstracts are already available [ 38 , 39 , 40 , 41 ], that could be adapted for dissertation research in health science.

In academic practice, skilled supervision alongside transparent and method-appropriate criteria are the precondition for confident and courageous dissertation research that increases understanding and challenges existing knowledge of health care research. Educational programs strengthening research and reporting skills – within and beyond qualitative methods – should be implemented into medical education more profoundly, at the latest in doctoral training.

Availability of data and materials

The data of the repository databank is semi-public and can be accessed from the corresponding author upon reasonable request. A data extraction table is available in App. 2.Competing interests and funding: We have no conflicts of interest to disclose and no funding to report.

Abbreviations

Consolidated criteria for reporting qualitative research

Doctor medicinae

Doctor medicinae dentariae

Doctor scientiarum humanarum

Medical Doctor

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Acknowledgements

We would like to thank Laura Svensson for assisting in reviewing the abstracts and data extraction. In addition, we would like to thank the reviewers for their thorough review and constructive comments.

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Charlotte Ullrich, Anna Stürmlinger, Michel Wensing & Katja Krug

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CU and KK conceived the idea for this manuscript. CU, KK and AS reviewed, extracted and analyzed the data. KK led the data analysis. CU wrote the first draft of the manuscript. MW provided substantial comments at different stages of the manuscript. CU, KK and MW critically revised the manuscript. All authors read and approved the manuscript for submission.

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Ullrich, C., Stürmlinger, A., Wensing, M. et al. Qualitative research methods in medical dissertations: an observational methodological study on prevalence and reporting quality of dissertation abstracts in a German university. BMC Med Res Methodol 20 , 301 (2020). https://doi.org/10.1186/s12874-020-01186-6

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